Telemedicine and e-Health in the Management of Psoriasis
The COVID-19 pandemic has opened up new opportunities in telemedicine, including for people who have psoriasis. In most cases, medical management of psoriasis can be safely and effectively handled via this medium.
The term “telehealth” is used even more broadly, to include technology used to collect and send patient data, such as email and remote patient monitoring.
A wide variety of technologies can be employed to take advantage of telemedicine. Telemedicine can include videoconferencing, such as through Zoom, Skype, or FaceTime. Specific telemedicine apps, such as MDLive, are also available.
Although not ideal, a telemedicine visit can even happen over a simple telephone call if necessary. Less commonly, encounters might happen asynchronously, like if you sent information to a healthcare provider but weren’t engaging in real-time. But usually, that isn’t what people mean by a telemedicine visit.
Telehealth access has grown dramatically in recent years as the available technologies have improved.2 This has been especially important for people in rural and remote areas, who might have otherwise lacked easy access to a specialist.
However, the COVID-19 pandemic has expanded telemedicine options even further. Some regulations have been loosened regarding telehealth, such as allowing certain communication platforms that hadn’t previously been authorized. Healthcare providers are also receiving much better and more reliable reimbursement for these visits.
Switching to Telemedicine
Many dermatology and primary care practices who previously did not offer telemedicine now are including this as an option.1 In some cases, practices are encouraging telemedicine over in-person visits, at least for higher-risk patients.
You may also be able to set up a telemedicine appointment with a new medical provider, even if you’ve never seen them for an in-person visit. You can find a healthcare provider who treats psoriasis in the same way that you normally would—from a referral from your healthcare provider or by checking with your insurance company.
Call your healthcare provider’s office directly to see what telemedicine options are available. Telemedicine options are now widely available for primary care physicians and dermatologists.
Telemedicine also may be an option even if you don’t have insurance. There are private-pay telehealth providers (such as Teledoc) that may be able to meet your needs. You can also try calling a local healthcare provider and see if they accept patients without insurance for telemedicine appointments.
What Should I Do Ahead of Time?
You can call your health clinic to find out what platform will be used for your telemedicine appointment. If you don’t already have it, you will need to set it up on the device you plan to use. For a video chat, you will need a stable, high-speed internet connection. If you are using your phone, logging on to wi-fi usually works best.4
If you haven’t used a specific platform before, it’s helpful to do a practice run ahead of time with a family member or friend. If you’ve never had a telemedicine visit before, some clinics will have a support person call you ahead of time. Fortunately, most of the platforms are relatively easy to use, even if you aren’t very tech-savvy.
If possible, plan to have your telemedicine appointment in a quiet room with good lighting, to better interact with your healthcare provider. Make sure your device is fully charged ahead of time.
It’s also a good idea to gather certain supplies in advance of your visit. These might include:
- A backup phone and medical office phone number, for any audio issues
- A list of questions/concerns to share with your healthcare provider
- Pen and paper, to take notes about follow-up questions or next steps
- Supplies you might need for the exam, if available (thermometer, scale, blood pressure cuff)
- A list of your current medications and supplements (or a physical container with all of them)
You can also use our downloadable Healthcare Provider Discussion Guide below, which can help you prepare by teaching you relevant terminology, suggesting questions to ask your healthcare provider, and more.
How Will the Appointment Work?
You’ll need to make contact at your appointment time using the platform specified by your healthcare provider’s office. It’s fine to have a family member with you for the visit, the same way you might at an in-person visit.
Some things will be similar to the way you’d have an appointment in person, but some parts will have to be adapted or skipped. The exact nature of the encounter may vary based on whether you are a new patient and on the exact nature of the problem (e.g., regularly scheduled follow-up or unscheduled disease flare).
As is usually the case, you’ll start by checking in with your healthcare provider about your recent medical issues, describing in detail your most recent symptoms. For example, you’d explain if your psoriasis rash has become more widespread over your skin or more severe in the affected areas. If a first-time appointment, you’d provide your clinician with a full medical history.
The exam portion of the visit will obviously be different. Depending on the circumstances, your healthcare provider might have you take your own vital signs, like your weight and your temperature. If you have your own equipment to take your blood pressure at home, you might get that as well. However, these might not be necessary.
Normally, your clinician would usually look closely at your affected areas of skin. This is especially important at a first visit if you’ve never been diagnosed with psoriasis before.
That isn’t possible during a telemedicine visit, but your clinician may ask to see your affected areas of skin up close with the camera, if you can manage that. You might be asked to take a picture with a smartphone and send it virtually.5 Make sure the images are in focus. Sometimes it’s helpful to get pictures both close-up and at more of a distance.
Working together, you and your healthcare provider will plan your treatment, including any follow-up steps. Depending on the situation, this might mean deciding to do a future in-person visit, an in-person treatment (such as an infusion), or follow-up blood tests. Or you might make a treatment plan with the idea of following up via telemedicine.
When Does Telemedicine Work for Psoriasis?
Telemedicine can often be especially helpful for a follow-up visit if you’ve previously seen a healthcare provider for an in-person visit. It’s especially easy to do if your disease is relatively stable and you just need to check-in with a practitioner. It can work pretty well if you are having an exacerbation of skin symptoms.
Telemedicine works well as an initial screening visit if you aren’t sure if you need to be seen in person. You may need to see someone in-person if you haven’t yet received a diagnosis of psoriasis and the diagnosis isn’t clear.6 Or you might need to see a healthcare provider in-person if your disease isn’t adequately responding to treatment.
Telemedicine also doesn’t work for certain types of psoriasis treatments. For example, Remicade (infliximab) is one treatment for psoriasis commonly given via infusion in an office.7 Such infusions aren’t typically given at home. You’ll have to plan with your healthcare provider about how to handle your treatment and whether there is another choice.
How Well Does Telemedicine Work for Psoriasis?
Research on telemedicine specifically in people with psoriasis is limited. However, general studies have shown that telemedicine can be surprisingly effective a lot of the time. Telemedicine may be easier to adapt for dermatological conditions like psoriasis because a hands-on exam isn’t as important as it is for some other specialties.
One study of almost 300 people with psoriasis found that a telemedicine model was just as effective as standard in-person treatment at reducing symptoms.8 On the whole, people getting care for dermatological issues report high rates of patient satisfaction, and the telemedicine seems to work just as well for diagnosis as in-person visits.
Should I Choose Telemedicine?
Depending on your specific situation and your local health conditions, you may have an option about whether to get a virtual telemedicine appointment with your healthcare provider or an in-person one.
At present, many people are choosing telemedicine because of concerns about contracting COVID-19. Whether or not psoriasis puts one at high risk for severe symptoms of COVID-19 is unclear, but psoriasis is linked to some medical conditions (such as obesity and heart disease) that do seem to increase the risk of having a bad case.
Some people with psoriasis also take immunosuppressive medications that might make them more likely to become infected or have a worse outcome, but this isn’t completely clear.
Telemedicine offers some benefits even without these concerns. Many patients find it convenient, especially for follow-up appointments for which not a lot has changed. People who live a long way from their healthcare provider may especially benefit from the reduced time needed to make a telemedicine visit.
Currently, medical offices are performing intense infection control measures, such as aggressive disinfection, patient pre-screening, social distancing, and appointment spacing. You can always contact your local office about their practices. In any case, it may be a perfectly reasonable choice to plan for an in-person appointment, even if telemedicine is an option for you.
It doesn’t have to be either/or. You might choose to mostly see your healthcare provider over telemedicine but come into the office if a particular issue comes up. If you have never seen your healthcare provider in-person, at some point you will probably want to do at least one comprehensive in-person visit. Work with your healthcare provider to see what makes sense for you.
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